目的 探討碳酸鑭聯(lián)合左卡尼汀治療維持性血液透析慢性腎功能衰竭的臨床療效。方法 選取2019年1月—2021年12月在滄州市中心醫(yī)院進(jìn)行治療的88例維持性血液透析慢性腎功能衰竭患者為研究對象，根據(jù)住院號的奇偶分為對照組和治療組，每組各44例。對照組靜脈滴注左卡尼汀注射液，50 mg/kg同0.9%氯化鈉注射液100 mL配伍，1次/d；治療組在對照組治療基礎(chǔ)上口服碳酸鑭咀嚼片，0.5 g/次，3次/d。兩組均連續(xù)治療3個(gè)月。觀察兩組的臨床療效，比較兩組治療前后相關(guān)量表評分、腎功能指標(biāo)、骨代謝指標(biāo)、細(xì)胞因子指標(biāo)和血管鈣化積分的變化情況。結(jié)果 治療后，治療組總有效率是93.18%，顯著高于對照組的81.82%（P＜0.05）。治療后，兩組生活質(zhì)量綜合評定問卷（GQOLI-74）評分、社會(huì)支持評定量表（SSRS）評分、慢性病患者生命質(zhì)量測定量表體系（QLICD-CRF 2.0）評分均較治療前顯著升高，但急性生理與慢性健康（APACHEⅡ）評分、SAPSⅡ評分均顯著降低（P＜0.05），并以治療組改善的更明顯（P＜0.05）。治療后，兩組患者血肌酐（Scr）、尿素氮（BUN）水平均較治療前顯著降低，但內(nèi)生肌酐清除率（Ccr）水平均顯著升高（P＜0.05）；治療后，治療組腎功能指標(biāo)改善優(yōu)于對照組（P＜0.05）。治療后，兩組血鈣（Ca）血磷（P）、全段甲狀旁腺激素（iPTH）水平均較治療前顯著降低（P＜0.05），并以治療組改善更明顯（P＜0.05）。治療后，兩組血清基質(zhì)金屬蛋白酶-9（MMP-9）、胱抑素C（CysC）、基質(zhì)細(xì)胞衍生因子-1（TSP-1）、β2-微球蛋白（β2-MG）、人成纖維細(xì)胞生長因子-23（FGF-23）均較同組治療前顯著降低，而骨形態(tài)發(fā)生蛋白-7（BMP-7）顯著升高（P＜0.05），并以治療組改善更明顯（P＜0.05）。治療后，兩組患者冠狀動(dòng)脈鈣化（CACS）積分、腹主動(dòng)脈鈣化（AACS）積分均顯著降低（P＜0.05），并以治療組改善更明顯（P＜0.05）。結(jié)論 碳酸鑭聯(lián)合左卡尼汀治療維持性血液透析慢性腎功能衰竭療效明顯，可有效改善患者腎功能和骨代謝指標(biāo)，改善血清細(xì)胞因子水平，延緩血管鈣化，有著良好的臨床應(yīng)用價(jià)值。

Objective To investigate the clinical efficacy of lanthanum carbonate combined with levocarnitine in treatment of chronic renal failure on maintenance hemodialysis. Methods A total of 88 patients with chronic renal failure on maintenance hemodialysis who were treated in Cangzhou Central Hospital from January 2019 to December 2021 were selected as the research objects, and were divided into control group and treatment group according to the oddities of hospitalization number, with 44 cases in each group. Patients in the control group were iv administered with Levocarnitine Injection, 50 mg/kg compatible with 0.9% sodium chloride injection 100 mL, once daily. Patients in the treatment group were po administered with Lanthanum Carbonate Chewable Tablets on the basis of the control group, 0.5 g/time, 3 times daily. Both groups were treated for 3 months. The clinical efficacy of the two groups were observed, and the changes of related scales scores, renal function indexes, bone metabolism indexes, cytokine indexes and vascular calcification scores were compared between the two groups before and after treatment. Results After treatment, the total effective rate in the treatment group was 93.18%, significantly higher than that in the control group (81.82%, P < 0.05). After treatment, scores of comprehensive Assessment questionnaire (GQOLI-74), Social Support Rating Scale (SSRS) and QLICD-CRF 2.0 (QLICD-CRF 2.0) in two groups were significantly increased compared with before treatment, but APACHEⅡ score and SAPSⅡ score were significantly decreased (P < 0.05). The improvement was more obvious in the treatment group (P < 0.05). After treatment, the levels of serum creatinine (Scr) and urea nitrogen (BUN) in two groups were significantly decreased compared with before treatment, but endogenous creatinine clearance (CCR) level was significantly increased (P < 0.05). After treatment, the renal function index of the treatment group improved better than that of the control group (P < 0.05). After treatment, the levels of blood calcium (Ca), blood phosphorus (P), and whole parathyroid hormone (iPTH) in two groups were significantly decreased compared with those before treatment (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). After treatment, the serum levels of matrix metalloproteinase-9 (MMP-9), cystatin C (CysC), stromal cell derived factor-1 (TSP-1), β2-microglobulin (β2-MG) and human fibroblast growth factor-23 (FGF-23) in two groups were significantly lower than those before treatment. However, bone morphogenetic protein-7 (BMP-7) was significantly increased (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). After treatment, coronary artery calcification (CACS) score and abdominal aortic calcification (AACS) score were significantly decreased in two groups (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). Conclusion Lanthanum carbonate combined with levocarnitine have obvious curative effect in treatment of chronic renal failure on maintenance hemodialysis, and can effectively improve renal function, bone metabolism index, and serum cytokines, and also can delay vascular calcification, which has good clinical application value.

R975

滄州市重點(diǎn)研發(fā)計(jì)劃指導(dǎo)項(xiàng)目(204106081)